Estimating survival in patients with gastrointestinal cancers and brain metastases: An update of the graded prognostic assessment for gastrointestinal cancers (GI-GPA)

Paul W. Sperduto, P. Fang, Jing Li, William Breen, Paul D. Brown, Daniel Cagney, Ayal Aizer, James B. Yu, Veronica Chiang, Supriya Jain, Laurie E. Gaspar, Sten Myrehaug, A. Sahgal, S. Braunstein, P. Sneed, B. Cameron, Albert Attia, J. Molitoris, Cheng Chia Wu, Tony J.C. WangNatalie A. Lockney, Kathryn Beal, Jessica Parkhurst, John M. Buatti, Ryan Shanley, Emil Lou, Daniel D. Tandberg, John P. Kirkpatrick, D. Shi, Helen A. Shih, Michael Chuong, Hirotake Saito, Hidefumi Aoyama, L. Masucci, D. Roberge, Minesh P. Mehta

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Background: Patients with gastrointestinal cancers and brain metastases (BM) represent a unique and heterogeneous population. Our group previously published the Diagnosis-Specific Graded Prognostic Assessment (DS-GPA) for patients with GI cancers (GI-GPA) (1985–2007, n = 209). The purpose of this study is to update the GI-GPA based on a larger contemporary database. Methods: An IRB-approved consortium database analysis was performed using a multi-institutional (18), multi-national (3) cohort of 792 patients with gastrointestinal (GI) cancers, with newly-diagnosed BM diagnosed between 1/1/2006 and 12/31/2017. Survival was measured from date of first treatment for BM. Multiple Cox regression was used to select and weight prognostic factors in proportion to their hazard ratios. These factors were incorporated into the updated GI-GPA. Results: Median survival (MS) varied widely by primary site and other prognostic factors. Four significant factors (KPS, age, extracranial metastases and number of BM) were used to formulate the updated GI-GPA. Overall MS for this cohort remains poor; 8 months. MS by GPA was 3, 7, 11 and 17 months for GPA 0–1, 1.5–2, 2.5–3.0 and 3.5–4.0, respectively. >30% present in the worst prognostic group (GI-GPA of ≤1.0). Conclusions: Brain metastases are not uncommon in GI cancer patients and MS varies widely among them. This updated GI-GPA index improves our ability to estimate survival for these patients and will be useful for therapy selection, end-of-life decision-making and stratification for future clinical trials. A user-friendly, free, on-line app to calculate the GPA score and estimate survival for an individual patient is available at brainmetgpa.com.

Original languageEnglish (US)
Pages (from-to)39-45
Number of pages7
JournalClinical and Translational Radiation Oncology
Volume18
DOIs
StatePublished - Sep 2019

Keywords

  • Brain metastases
  • End-of-life
  • Gastrointestinal cancers
  • Prognosis

PubMed: MeSH publication types

  • Journal Article

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    Sperduto, P. W., Fang, P., Li, J., Breen, W., Brown, P. D., Cagney, D., Aizer, A., Yu, J. B., Chiang, V., Jain, S., Gaspar, L. E., Myrehaug, S., Sahgal, A., Braunstein, S., Sneed, P., Cameron, B., Attia, A., Molitoris, J., Wu, C. C., ... Mehta, M. P. (2019). Estimating survival in patients with gastrointestinal cancers and brain metastases: An update of the graded prognostic assessment for gastrointestinal cancers (GI-GPA). Clinical and Translational Radiation Oncology, 18, 39-45. https://doi.org/10.1016/j.ctro.2019.06.007